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AP5: C Flashcards

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1
Q

Which of the following best describes Hyperaemia?

A. A passive process resulting from reduced venous drainage.; B. An active process due to arterial and arteriolar dilatation.; C. A condition characterized by a bluish skin tint (cyanosis).; D. The accumulation of fluid in the interstitial space.

A

B. An active process due to arterial and arteriolar dilatation.

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2
Q

Generalised passive venous congestion is most commonly found in patients suffering from ______.

A

Heart failure

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3
Q

Which of the following organs are characteristically affected by long-standing (chronic) congestion?

A. Lung; B. Liver; C. Pancreas; D. Spleen

A

A,B,D

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4
Q

What are ‘heart failure cells’ and how do they form?

A

They are macrophages in the lungs that have taken up haemosiderin. They form when chronic congestion causes alveolar capillaries to leak red blood cells, which are then broken down in the alveoli

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5
Q

In a cut section of a congested liver, the ‘nutmeg’ appearance is caused by:

A. Central veins appearing red surrounded by yellowish-brown normal liver.; B. Diffuse fibrosis of the portal system.; C. Accumulation of fat in the central veins.; D. Small haemorrhages in the peripheral liver cells.

A

A. Central veins appearing red surrounded by yellowish-brown normal liver

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6
Q

Severe generalised oedema is referred to as ______.

A

Anasacra

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7
Q

Which mechanisms contribute to the development of Oedema?

A. Increased hydrostatic pressure.; B. Increased colloid osmotic pressure.; C. Lymphatic obstruction.; D. Sodium and water retention.

A

A,C,D

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8
Q

Contrast Transudate and Exudate oedema fluid.

A

Transudates result from hydrostatic/osmotic imbalances with normal vascular permeability. Exudates result from increased vascular permeability, often associated with inflammation

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9
Q

A 25-year-old patient presents with massive protein loss from the kidneys. This renal oedema is primarily caused by:

A. Increased hydrostatic pressure.; B. Reduced vascular colloid osmotic pressure due to hypoalbinumaemia.; C. Lymphatic obstruction.; D. Arteriolar dilation.

A

B. Reduced vascular colloid osmotic pressure due to hypoalbinumaemia

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10
Q

Haemorrhage into the skin or mucous membranes that is large and blotchy (greater than 1cm) is called ______.

A

Ecchymosis

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11
Q

Which of the following are components of the Virchow’s Triad in thrombosis?

A. Endothelial injury.; B. Abnormal blood flow (stasis or turbulence).; C. Hypercoagulability.; D. Increased fibrinolysis.

A

A,B,C

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12
Q

Explain the evolution of a bruise (haemorrhage) from purple to brown.

A

It follows the breakdown of blood pigments: starting with haemoglobin (red/purple), it is converted to bilirubin (blue/green), and eventually to haemosiderin (brown)

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13
Q

Which molecule, released by endothelial cells, is responsible for the reflex neurogenic vasoconstriction immediately following vascular injury?

A. Thrombin.; B. Histamine.; C. Endothelin.; D. ADP.

A

C. Endothelin

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14
Q

The process where older thrombi become organised by other cells and capillaries form to re-establish blood flow is called ______.

A

Recanalization

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15
Q

What are the possible ‘fates’ of a thrombus?

A. Propagation.; B. Embolization.; C. Dissolution.; D. Metastasis.

A

A, B, C (Note: Organization/Recanalization is also a fate).

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16
Q

Define an Embolus.

A

An embolus is an abnormal mass of undissolved material (solid, liquid, or gas) that is transported from one part of the circulatory system to another

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17
Q

Where do the majority of pulmonary thrombo-emboli (PE) originate?

A. Right atrium.; B. Deep vein thrombosis (DVT) of the lower limbs.; C. Atherosclerotic plaques in the aorta.; D. Left ventricular wall.

A

B. Deep vein thrombosis (DVT) of the lower limbs

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18
Q

A large pulmonary embolus that lodges at the bifurcation of the pulmonary artery is called a ______ embolus.

A

Saddle

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19
Q

Which clinical features characterize Fat Embolism Syndrome?

A. Respiratory distress.; B. Mental confusion.; C. Petechial haemorrhage.; D. Massive hematemesis.

A

A,B,C

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20
Q

Describe the mechanism of decompression sickness in scuba divers.

A

Air breathed at high pressure causes nitrogen to dissolve in tissues. If the diver ascends too rapidly, the sudden reduction in pressure causes the nitrogen to come out of solution, forming gas bubbles in the blood and tissues

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21
Q

In the autopsy of a patient who died from amniotic fluid embolism, which finding is classic in the pulmonary microvasculature?

A. Large fibrin clots only.; B. Squamous cells shed from foetal skin.; C. Air bubbles.; D. Calcium deposits.

A

B. Squamous cells shed from foetal skin

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22
Q

Area of ischaemic necrosis caused by occlusion of arterial supply or venous drainage is called an ______.

A

Infarct/ Infarction

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23
Q

Which factors determine the extent and severity of ischaemia?

A. Presence of a double or collateral blood supply.; B. Rate of onset of ischaemia.; C. The sensitivity of the tissue to hypoxia (e.g., brain).; D. The patient’s blood type.

A

A,B,C

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24
Q

Differentiate between ‘White’ and ‘Red’ infarcts.

A

White (pale) infarcts occur in solid organs with end-arterial circulation like the heart or spleen. Red (haemorrhagic) infarcts occur in organs with dual blood supply (lungs/gut) or following venous occlusion

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25
Which organ is remarkably resistant to infarction because of its dual blood supply (hepatic artery and portal vein)? A. Spleen.; B. Kidney.; C. Liver.; D. Heart.
C. Liver
26
Ischaemic brain tissue undergoes ______ necrosis eventually forming a cystic space.
Colliquative/Liquefactive
27
Which of the following are examples of shock caused by 'Failure of the pump' (Cardiogenic shock)? A. Myocardial infarction.; B. Severe burns.; C. Pulmonary embolism.; D. Cardiac tamponade.
A,C,D (Burns cause Hypovolaemic shock)
28
Define Systemic Shock at the cellular level.
It is a state of circulatory failure where oxygen deficit leads to a switch to anaerobic glycolysis, resulting in the accumulation of lactic acid and metabolic lactic acidosis
29
During the 'Progressive Phase' of shock, what is the primary clinical characteristic? A. Maintenance of vital organ perfusion.; B. Tissue hypoperfusion and worsening metabolic imbalances.; C. Instantaneous cellular death.; D. Activation of reflex compensatory mechanisms.
B. Tissue hypoperfusion and worsening metabolic imbalances
30
The development of 'shock kidney' is characterized by acute ______ necrosis.
Tubular
31
What are the pathological features of shock in the Lungs? A. Lungs are red and heavy.; B. Presence of hyaline membranes (ARDS).; C. Lipid depletion.; D. Congestion and oedema.
A,B,D
32
What is DIC (Disseminated Intravascular Coagulation) and why is it paradoxical?
DIC is the widespread activation of the coagulation complex leading to microthrombi and platelet depletion. It is paradoxical because excessive coagulation is accompanied by haemorrhagic complications due to the consumption of clotting factors and inhibition by fibrin degradation products
33
In the early stages of shock death typically results from: A. Acute tubular necrosis.; B. Circulatory collapse leading to cerebral ischaemia or heart failure.; C. Metabolic lactic acidosis.; D. Bronchopneumonia.
B. Circulatory collapse leading to cerebral ischaemia or heart failure
34
In chronic passive venous congestion of the spleen, the organ is enlarged and firm, often described as a '______ spleen.'
Cricket-ball
35
Which of the following can cause Local Passive Venous Congestion?
A. Thrombus obstructing a vein.; B. Tumour pressing on
36
Why does the adrenal gland show lipid depletion during the stress response of shock?
37
Which type of shock is caused by IgE-mediated hypersensitivity resulting in acute vasodilation?
A. Septic shock; B. Neurogenic shock; C. Anaphylactic shock; D. Cardiogenic shock
38
Small, pinpoint haemorrhages (less than 3mm) are called ______.
39
Which findings are associated with Secondary Hemostasis?
A. Platelet aggregation.; B. Activation of the coagulation cascade.; C. Formation of thrombin.; D. Fibrin polymerization.
40
What is the clinical significance of a 'saddle embolus'?
41
Which of the following best describes Hyperaemia?
A. A passive process resulting from reduced venous drainage.; B. An active process due to arterial and arteriolar dilatation.; C. A condition characterized by a bluish skin tint (cyanosis).; D. The accumulation of fluid in the interstitial space.
42
Generalised passive venous congestion is most commonly found in patients suffering from ______.
43
Which of the following organs are characteristically affected by long-standing (chronic) congestion?
A. Lung; B. Liver; C. Pancreas; D. Spleen
44
What are 'heart failure cells' and how do they form?
45
In a cut section of a congested liver, the 'nutmeg' appearance is caused by:
A. Central veins appearing red surrounded by yellowish-brown normal liver.; B. Diffuse fibrosis of the portal system.; C. Accumulation of fat in the central veins.; D. Small haemorrhages in the peripheral liver cells.
46
Severe, generalised oedema is referred to as ______.
47
Which mechanisms contribute to the development of Oedema?
A. Increased hydrostatic pressure.; B. Increased colloid osmotic pressure.; C. Lymphatic obstruction.; D. Sodium and water retention.
48
Contrast Transudate and Exudate oedema fluid based on vascular permeability.
49
A 25-year-old patient presents with massive protein loss from the kidneys. This renal oedema is primarily caused by:
A. Increased hydrostatic pressure.; B. Reduced vascular colloid osmotic pressure due to hypoalbinumaemia.; C. Lymphatic obstruction.; D. Arteriolar dilation.
50
Haemorrhage into the skin or mucous membranes that is large and blotchy (greater than 1cm) is called ______.
51
Which of the following are components of Virchow’s Triad in thrombosis?
A. Endothelial injury.; B. Abnormal blood flow (stasis or turbulence).; C. Hypercoagulability.; D. Increased fibrinolysis.
52
Explain the evolution of a bruise (haemorrhage) at the pigment level.
53
Which molecule, released by endothelial cells, is responsible for the reflex neurogenic vasoconstriction immediately following vascular injury?
A. Thrombin.; B. Histamine.; C. Endothelin.; D. ADP.
54
The process where older thrombi become organised by other cells and capillaries form to re-establish blood flow is called ______.
55
What are the possible 'fates' of a thrombus?
A. Propagation.; B. Embolization.; C. Dissolution.; D. Metastasis.
56
Define an Embolus.
57
Where do the majority of pulmonary thrombo-emboli (PE) originate?
A. Right atrium.; B. Deep vein thrombosis (DVT) of the lower limbs.; C. Atherosclerotic plaques in the aorta.; D. Left ventricular wall.
58
A large pulmonary embolus that lodges at the bifurcation of the pulmonary artery is called a ______ embolus.
59
Which clinical features characterize Fat Embolism Syndrome?
A. Respiratory distress.; B. Mental confusion.; C. Petechial haemorrhage.; D. Massive hematemesis.
60
Describe the mechanism of decompression sickness in scuba divers.
61
In the autopsy of a patient who died from amniotic fluid embolism, which finding is classic in the pulmonary microvasculature?
A. Large fibrin clots only.; B. Squamous cells shed from foetal skin.; C. Air bubbles.; D. Calcium deposits.
62
Area of ischaemic necrosis caused by occlusion of arterial supply or venous drainage is called an ______.
63
Which factors determine the extent and severity of ischaemia?
A. Presence of a double or collateral blood supply.; B. Rate of onset of ischaemia.; C. The sensitivity of the tissue to hypoxia (e.g., brain).; D. The patient's blood type.
64
Differentiate between 'White' and 'Red' infarcts based on the organs they affect.
65
Which organ is remarkably resistant to infarction because of its dual blood supply?
A. Spleen.; B. Kidney.; C. Liver.; D. Heart.
66
Ischaemic brain tissue undergoes ______ necrosis, eventually forming a cystic space.
67
Which of the following are examples of shock caused by 'Failure of the pump' (Cardiogenic shock)?
A. Myocardial infarction.; B. Severe burns.; C. Pulmonary embolism.; D. Cardiac tamponade.
68
Define Systemic Shock at the cellular level.
69
During the 'Progressive Phase' of shock, what is the primary clinical characteristic?
A. Maintenance of vital organ perfusion.; B. Tissue hypoperfusion and worsening metabolic imbalances.; C. Instantaneous cellular death.; D. Activation of reflex compensatory mechanisms.
70
The development of 'shock kidney' is characterized by acute ______ necrosis.
71
What are the pathological features of shock in the Lungs?
A. Lungs are red and heavy.; B. Presence of hyaline membranes (ARDS).; C. Lipid depletion.; D. Congestion and oedema.
72
What is DIC (Disseminated Intravascular Coagulation) and why is it paradoxical?
73
In the early stages of shock, death typically results from:
A. Acute tubular necrosis.; B. Circulatory collapse leading to cerebral ischaemia or heart failure.; C. Metabolic lactic acidosis.; D. Bronchopneumonia.
74
In chronic passive venous congestion of the spleen, the organ is enlarged and firm, often described as a '______ spleen.'
75
Which of the following can cause Local Passive Venous Congestion?
A. Thrombus obstructing a vein.; B. Tumour pressing on a vein.; C. Right heart failure.; D. Varicose veins.
76
Why does the adrenal gland show lipid depletion during the stress response of shock?
77
Which type of shock is caused by IgE-mediated hypersensitivity resulting in acute vasodilation?
A. Septic shock.; B. Neurogenic shock.; C. Anaphylactic shock.; D. Cardiogenic shock.
78
Small, pinpoint haemorrhages are called ______.
79
Which findings are associated with Secondary Hemostasis?
A. Platelet aggregation.; B. Activation of the coagulation cascade.; C. Formation of thrombin.; D. Fibrin polymerization.
80
What is the clinical significance of a 'saddle embolus'?
81
In chronic passive venous congestion of the liver, central liver cells undergo ______ while peripheral cells show fatty change.
A. Necrosis.; B. Hypertrophy.; C. Atrophy.; D. Metaplasia.
82
In chronic passive venous congestion of the spleen, the red pulp contains foci of haemorrhage called ______ bodies.
83
Explain the mechanism of Pulmonary Oedema in left-sided heart failure.
84
Which of the following are causes of Lymph Oedema?
A. Radical mastectomy.; B. Parasitic filariasis.; C. Sudden standing.; D. Congenital malformations.
85
Which type of brain oedema is characterized by swelling of the brain that can lead to herniation?
A. Cytotoxic.; B. Vasogenic.; C. Interstitial.; D. All of the above.
86
Thromboxane A2 is released by platelets to induce platelet ______.
87
How does Factor V Leiden mutation contribute to thrombosis?
88
Which of the following lead to Abnormal Blood Flow (Stasis or Turbulence)?
A. Atrial fibrillation.; B. Aneurysms.; C. Hypertension.; D. Atherosclerotic narrowing.
89
A 'paradoxical embolus' refers to:
A. An arterial embolus lodging in the brain.; B. A venous thrombus crossing into the arterial circulation.; C. A fat embolus after a fracture.; D. An air embolus during surgery.
90
In amniotic fluid embolism, the infusion of fluid into maternal circulation often occurs via a tear in the ______ membranes.
91
Why is a gradual onset of ischaemia (e.g., atheroma) often less severe than a sudden onset?
92
Which factors make Permanent Tissue like the brain highly susceptible to ischaemia?
A. High sensitivity to hypoxia.; B. Lack of dual blood supply.; C. High metabolic rate.; D. Capacity for rapid regeneration.
93
Which artery is most commonly affected in a localized Myocardial Infarction?
A. Right coronary artery.; B. Left circumflex artery.; C. Anterior descending branch of left coronary artery.; D. Posterior descending artery.
94
A circumferential subendocardial infarct involves the inner ______ of the left ventricular wall.
95
What is the macroscopic appearance of a Pulmonary Infarct?
96
Which of the following are characteristics of Splenic Infarcts?
A. Wedge-shaped.; B. Always haemorrhagic.; C. Capsule involvement causing peritonitis.; D. Commonly pale.
97
Ischaemic bowel that is not treated surgically can lead to:
A. Healing by fibrosis.; B. Resolution.; C. Gangrene due to putrefactive organisms.; D. Chronic passive congestion.
98
Healing of a brain infarct occurs by ______.
99
Describe the appearance of a Shock Kidney at autopsy.
100
Which of the following occur during the Irreversible Phase of shock?
A. Reflex compensatory mechanisms.; B. Survival is not possible even with haemodynamic correction.; C. Severe cellular and tissue injury.; D. Perfusion of vital organs is maintained.
B4
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